I do think we have frustrated primary care and have put in place some over-bureaucratic processes. However, if we are to meet the future financial challenge we both need to align.

Primary care needs to take up the mantle of commissioning and embrace the responsibility and accountability it requires.

In all the PCTs I have led, we have had excellent primary care. However, being a new GP does not necessarily mean you're a good manager. The skills are different and we need both.

I have seen excellent GPs; I've also seen poor practice. The curve of distribution is the same for management, however, I would say that NHS managers have a passion, a desire to improve care for patients, often work long hours in challenging circumstances and I am proud to be part of it.

It's okay to quote Staffs but where were the doctors when mortality was going up? Your headlines don't help.

Can we all get out of the trenches, stop throwing mud and recognise the skills we all have and move forward. What we need now is doing; doing on an industrial scale and that requires the knowledge and skills of primary care and the excellence in management of NHS managers

Dr Paul Zollinger-Read, Cambridgeshire